Patient to surgeon infections--fact or fiction.
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Costs and Cost Analysis↗
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Results for “Needlestick Injuries”
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Management of iatrogenic radial artery perforation.
The aim of this study was to evaluate a new protocol allowing coronary angiography to be performed transradially in spite of the occurrence of iatrogenic radial artery perforation during catheterization. Nine patients with iatrogenic radial artery perforation were managed conservatively by inserting a long arterial sheath in the damaged radial artery up to the brachial artery, after which the diagnostic and/or interventional procedures that had motivated transradial catheterization were completed via the protected radial artery. Radial angiography performed immediately thereafter showed no extravasation, and no major vascular complications developed during follow-up. The day after the procedure, two patients had asymptomatic radial occlusion, but the other seven patients had normal radial pulses and reversed Allen test responses showing normal perfusion. A conservative management technique, installation of a long arterial sheath not only promotes resolution of iatrogenic radial artery perforation but also allows the procedures motivating catheterization to be completed transradially.
Aged↗
Impact of the HIV epidemic on therapeutic apheresis: nursing considerations.
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Attitude of Health Personnel↗
HIV infection at home and in the workplace.
Major questions have been raised concerning an individual's risk for contracting HIV infection when they come into contact with a patient who has AIDS in the home and/or workplace. Specific concerns are addressed and guidelines are reviewed.
Adolescent↗
Virus-inhibiting surgical glove to reduce the risk of infection by enveloped viruses.
Needle puncture and other accidents that occur during surgery and other procedures may lead to viral infections of medical personnel, notably by hepatitis C (HCV) and human immunodeficiency virus (HIV), now that hepatitis B can be prevented by vaccination. A new surgical glove called G-VIR, which contains a disinfecting agent for enveloped viruses, has been developed. Herpes simplex type 1 (HSV) was used as a standard enveloped virus in both in vitro and in vivo tests of the virucidal capacity of the glove. Bovine viral diarrhea virus (BVDV) and feline immunodeficiency virus (FIV) were used as models for HCV and HIV, respectively. For in vitro study, a contaminated needle was passed through a glove and residual virus was titrated; for in vivo studies, animals were stuck with a contaminated needle through a glove. Despite variation in virus enumeration inherent in the puncture technique, statistical evaluation showed that infection was reproducibly and substantially reduced by passage through the virucidal layer. For BVDV, the amount of virus passing through the virucidal glove was reduced in 82% of pairwise comparisons with control gloves that lacked the virucidal agent; when plaque counts were adjusted to a common dilution, the median count for the virucidal glove was on the average reduced >10-fold. In experiments in which the proportion of wells infected with FIV was measured, the ratio of TCID(50) values (control glove to G-VIR) was >15, and probably much higher. For HSV, the amount of virus passing through the virucidal glove was reduced in 81% of comparisons with control gloves; the median of adjusted plaque counts was reduced on the average approximately eightfold or ninefold. In vivo tests with FIV and HSV in cats and mice, respectively, found smaller percentage reductions in infection than the in vitro tests but confirmed the virucidal effect of the gloves.
Animals↗
Intraoperative infectious disease exposure to otolaryngology operating room personnel.
Health care workers are at risk of exposure to serious infectious diseases. Since the seroconversion rate is approximately 0.4% for human immunodeficiency virus and may be greater than 20% for hepatitis exposure, these risks are substantial. To assess body fluid exposure to otolaryngology operating room personnel, elective operations were prospectively analyzed over 2 months. Statistical evaluation was made between types of cases and length of procedures. Thirty-eight contaminations occurred in 228 operations with 26 torn gloves, 1 soaked grown, 6 skin scratches, 4 skin punctures, and 1 ocular exposure. Exposure was more likely in cases longer than 3 hours. Independent of procedure length, head and neck operations carried the greatest risk, followed by otologic procedures, as compared to general, endoscopic, pediatric, and elective trauma cases. The impact of potential operative exposure and universal precautions is emphasized.
Blood↗
Restored antioxidant capacity parallels the immunologic and virologic improvement in children with perinatal human immunodeficiency virus infection receiving highly active antiretroviral therapy.
CD3+CD4+ T-lymphocyte numbers, viral load, and serum antioxidant capacity were evaluated in 20 children with perinatal human immunodeficiency virus (HIV) infection one month (T = -1) and one day (T = 0) before and one month (T = 1) and two months (T = 2) after a treatment switch to highly active antiretroviral therapy (HAART). Antioxidant capacity micromol/L) was evaluated by measuring the cuprous ion deriving from a known amount of cupric ion. Compared to control values (998 +/- 113 micromol/L), values in HIV-infected children were lower before HAART (T = -1, 848 +/- 211 micromol/L, P = 0.008; T = 0, 732 +/- 131 micromol/L, P < 0.0001), but similar during HAART (T = 1, 914 +/- 121 micromol/L, P = 0.089; T = 2; 957 +/- 155 micromol/L, P = 0.528; T = 1 and T = 2 vs T = 0, P < 0.0001). Immunologic and virologic improvement paralleled the restored antioxidant capacity. HAART may restore antioxidant capacity suppressing HIV, which inhibits antioxidant capacity. A positive feedback may be triggered since restored antioxidant capacity counterbalances the oxidative stress, which enhances lymphocyte apoptosis and HIV replication.
Adolescent↗
A light and electron microscopic study of the healing of pars plana incisions in the rhesus monkey.
Pars plana incisions were made in 11 rhesus monkey eyes. Six animals had injections of 0.1 ml of blood into the vitreous cavity with a 25-gauge needle and five animals had vitrectomy through a 4-mm incision with a multifunction vitrectomy probe. Six to 13 years later the scars in the pars plana were found to consist of fibrous tissue and blood vessels which extended from the episclera into the vitreous. The intravitreous scar was shaped by the incarceration of vitreous strands in the internal aspect of the wounds. There were quantitative, but no qualitative differences between the two types of incision. The ultrastructural features were those of mature scar tissue: fibroblasts, adult collagen, uveal melanocytes, macrophages, myelinated and non-myelinated nerves, and capillaries with non-fenestrated endothelium. There were associated proliferative ciliary epithelial changes, but no evidence of ciliary epithelial metaplasia.
Animals↗
Clinical pharmacology of zidovudine and other 2',3'-dideoxynucleoside analogues.
Since the discovery of the acquired immunodeficiency syndrome (AIDS) in 1981, considerable progress has been made in the development of agents with anti-HIV activity. Zidovudine was one of the first 2'-3'-dideoxynucleosides to cause inhibition of human immunodeficiency virus (HIV) replication in vitro, by inhibiting the viral reverse transcriptase. Early trials showed that zidovudine results in clinical and immunological improvements and prolonged life in patients with AIDS or AIDS-related complex. However, haematological toxicity is the main drawback associated with zidovudine therapy. The initial recommended dose of zidovudine was 1500 mg per day, but recent studies have shown that dosages as low as 300 mg per day could be just as effective, without the severe haematological toxicity. Because zidovudine readily crosses the blood-brain barrier, it is used for the treatment of neurological diseases associated with HIV disease with some success. However, Kaposi's sarcoma does not respond to therapy with the drug. Apart from haematological toxicity, patients on long-term therapy with zidovudine may also develop resistance. Zidovudine use has also been associated with improvements in neurodevelopmental and growth velocity in HIV-infected children. The use of zidovudine as a prophylaxis has also been suggested, but the value of this is questionable. The combination of zidovudine with other agents, such as acyclovir and interferon, has a synergistic effect on the anti-HIV activity, with reduced drug toxicity. Other 2',3'-dideoxynucleoside analogues, such as dideoxycytidine (ddC) and dideoxyinosine (ddI) are effective anti-HIV agents and their use is also associated with both clinical and immunological improvements.(ABSTRACT TRUNCATED AT 250 WORDS)
Acquired Immunodeficiency Syndrome↗
HIV transmission in the provision of health care.
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Confidentiality↗
An evaluation of hospital emergency department (HED) adherence to universal precautions.
A longitudinal cross sectional study of Hospital Emergency Department (HED) procedures over a nine month period was conducted. A total of 1,541 procedures were observed on 56 randomly selected 8-h work shifts. Shifts were distributed: 34% day shift; 34% evening shift; and 32% on the night shift. Observations on the evening shift were oversampled to capture an adequate number of trauma patients. Observations were distributed: 33% day shift; 39% evening shift; and 28% on the night shift. Measurements included: type of procedure; adherence to specific barrier technique, i.e., use of gloves, gowns, masks, and eye protection; and occurrence of adverse exposure. Ten types of HED procedures were documented and analyzed. Computerized tracking of study observations established periodic rates of HED health care worker (HCW) adherence to universal precautions. These data are important for internal quality control/assurance programs and rate comparisons within and across institutions over time. The longitudinal evaluation of the database revealed that glove compliance increased over the period of the study and adverse exposure decreased. Conducting ongoing or periodic observational studies of this kind are important and necessary in order to gauge HED response to the epidemiologic challenges of urban society.
Cross-Sectional Studies↗
Procedure-related rate of contact of intensive care unit personnel with patient body fluids.
We prospectively recorded the frequency with which ICU personnel came in contact with body fluids in order to provide an empirical basis for the recommendation of relevant protective precautions. ICU personnel completed a questionnaire when performing a range of 29 standardized procedures. The rate of contact with body fluid was: manual ventilation (55%); catheterization of peripheral vein (36%); insertion of central venous catheter (69%); arterial puncture (18%); tracheal intubation (76%); tracheal extubation (87%); suction from mouth, pharynx or trachea (82%); drawing of blood sample (52%); establishing or discontinuing blood transfusion (50%); establishing or discontinuing infusion (20%); changing of wound dressing (52%). We suggest that the contact rates observed should be used in combination with a universal precautions policy, in order to identify procedures that are likely to involve contact with body fluid. By using gloves 95% of contacts to body fluid would have been prevented.
Body Fluids↗
Risk for occupational transmission of HIV infection among health care workers. Study in a Spanish hospital.
The aim of this study was to evaluate the HIV seroconversion rate associated with different types of occupational exposures in health care workers. A longitudinal study was conducted from January 1986 to October 1992 in a teaching hospital in Spain, where HIV infection is prevalent among patients. Each health care worker was asked to complete a questionnaire regarding age, sex, staff category, lace of exposure, other exposures, type of exposure, body fluid, infected material and HIV status of source patient. These health care workers were then followed up at 6 weeks, 3 months, 6 months and 12 months with repeated test for HIV antibody. Four hundred twenty three reports of occupational exposure were analysed. Nursing was the profession with more exposures (42.8%). Ninety five percent of total exposures were percutaneous, 4% mucous membrane contacts and 1% skin contacts, 88.3% were described as blood contact and 71.8% had resulted from needlestick and suture needles. Exposures from HIV-positive patients comprised 23.2% of occupational exposures. There was a significant difference in the length of follow-up in physicians (p = 0.00009) and nurses (p = 0.00001), when we compared HIV-positive patients with patients in whom the HIV status was unknown or negative. The HIV seroconversion rate was 0.00%. We consider that the risk of acquiring HIV infection via contact with a patient is low, but not zero. Well documented cases of seroconversion have been published.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
HIV transmission by needle stick and eczematous lesion--three cases from Germany.
Two cases of documented HIV-1 transmission by needle stick and one case of probable transmission by eczematous lesion in three nurses in Germany are reported in the period 1988 to 1991. In two of the cases the nurse knew of the AIDS status of the index patient. A review of the three cases reiterates the importance of repeated training on the prevention of accident and on measures to be taken after an accident, as well as the need to keep the workplace free of additional burden when AIDS or HIV-infected patients are treated.
Acquired Immunodeficiency Syndrome↗
Prevalence of HCV antibodies in health-care workers from northern Italy.
The prevalence of HCV antibodies was assessed in 407 health-care workers and in 253 control subjects by means of immunoassays based on recombinant antigens. The seroprevalence in the study group was fairly low (1.2%) and not statistically different from that of controls (0.8%). The relation of HBV and HCV infections was evaluated in 83 health-care workers and in 82 controls: in both groups anti-HCV positivity was weakly related (p less than 0.05) to the HBV infection. HCV infection was associated with working in high risk wards (4/5 cases) and with report of accidental needle pricks (4/5 cases). As evaluated by means of the available markers, HCV infections in health-care workers seem to be rare.
Adult↗
Risk of blood contact through surgical gloves in aesthetic procedures.
Evidence of glove perforation, and therefore blood contact, was evaluated in 100 consecutive pairs of gloves used in aesthetic surgical procedures. The surgeon (38.3%) was more likely than the assistant (22.5%) to have exposure. In only 15% of these cases were they aware of the exposure. The left index finger (44%) was the most common location of perforation and 29 of the 32 holes (90.6%) were in cases that lasted more than 2 hours.
Acquired Immunodeficiency Syndrome↗
A rare complication of renal biopsy in a child with membranoproliferative glomerulonephritis.
Percutaneous renal biopsy is essential for the definitive diagnosis of chronic glomerulonephritis. Large arteriovenous fistula (AVF) which is a rare complication of native renal biopsy is generally diagnosed in the first weeks after the procedure. We present a childhood membranoproliferative glomerulonephritis case with an enormous AVF presenting with severe hypertension 15 months after the biopsy that was successfully embolized. In conclusion, AVF must be considered in children having chronic glomerulonephritides even if hypertension appears late after the renal biopsy.
Aneurysm, False↗